Driving For Health

I know that I cannot be the only person interested in the politics of healthcare who thinks that the concept of an individual mandate is nearly as flawed as much of the commentariat seems to believe it is.

By way of example, although it is just one example of many I've seen, today in Slate Tim Noah writes:

If you want to drive a car, it's accepted that you have to buy private auto insurance. But that's conditional on enjoying the societal privilege of driving a car; you can avoid the requirement by choosing not to drive one. A mandate to buy private health insurance, however, would be conditional on … being alive.

This is ridiculous. We require you to buy car insurance because you, driving your car, are not just a hazard to yourself. You are also a hazard to those around you. That's why you have to buy collision coverage, but you don't have to buy coverage for damage you cause your own car. You can avoid the requirement to own car insurance by not partaking in the automotive sector.

Likewise you, as a human being, when you get sick, are not just a hazard to yourself. In particular, because our hospitals have been taught to treat the sick, regardless of their ability to pay, if you show up to a hospital destitute but very sick, they will treat you and, essentially, bill everyone else who comes in for your costs (by raising prices on the procedures that are paid for in order to keep profitable, etc.)

So it's totally reasonable to require anyone who partakes of our healthcare system to pay for insurance, by direct analogy to driving a car. Even if we didn't care about your health, we care about the effects you not taking care of your health have on the rest of the system.

By my estimate, the only way to avoid this problem is to allow people to opt out of buying health insurance, with the explicit understanding that they are then opting out of the health care system. Someone who doesn't want to pay State Farm to insure their car is always welcome not to ever drive, and anyone who doesnt want to pay Blue Cross to insure their body is always welcome not to ever go to a doctor.

However, I think we can all agree that we really don't want to start telling the doctors 'don't treat this patient if they don't have their Health Insurance ID Card on them at all times,' which means that the only really rational thing to do is to ensure that everyone has health insurance. Whether that's through public insurance (my preference) or mandates to purchase private insurance (probably a politically obligatory halfway measure), it simply will have to be done.